AMA Comments on ACA Implementation Regulations
As implementation of Affordable Care Act (ACA) provisions proceeds, the AMA is rapidly responding to regulatory proposals being issued by various federal agencies. Following is a summary of key regulations and opportunities for public comment that have been issued so far, with links to relevant federal documents and comments submitted by the AMA.
Meaningful administrative simplification would result in significant savings and benefits to physicians and the health care delivery and payment system.
May 17, 2012 comment letter to CMS
Legal barriers need to be removed in order for physicians to participate in the models of patient care, such as Accountable Care Organizations (ACOs), which will be tested under the new health care law.
The ACA offers states the option of implementing the Basic Health Program (BHP), which provides states 95 percent of what the federal government would have spent on tax credits and subsidies for out-of-pocket costs for adults with incomes between 133 and 200 percent of the federal poverty level (FPL), and for legally resident immigrants with incomes below 133 percent FPL who do not qualify for Medicaid. Individuals eligible for the BHP cannot receive subsidized coverage in the state exchange.
October 31, 2011 comment letter
Consumers are given the right to appeal health plan decisions.
July 25, 2011 comment letter to DOL, HHS and IRS
Section 1322(a) of ACA requires the Secretary of Health and Human Services (HHS) to establish the Consumer Operated and Oriented Plan (CO-OP) program. Operating as nonprofit organizations, CO-OPs will compete directly with established nonprofit and profit-seeking insurers.
September 15, 2011 comment letter to HHS
Insurers are required to cover certain evidence-based preventive services at no cost to plan enrollees.
September 17, 2010 comment letter to HHS
Individual and new employer health plans are required to make dependent coverage available until a child reaches the age of 26.
AMA did not comment
Effective in 2014, all qualified health benefits plans, including those offered in exchanges and in the individual and small group markets outside of exchanges, with the exception of grandfathered individual and employer-sponsored plans, will be required to offer at least the essential health benefits package.
December 21, 2012, AMA Comments to CMS
Effective for payments made after December 31, 2011, section 9006 of the ACA (incorporated as section 6041 of the internal Revenue Code) requires all businesses that pay any amount greater than $600 during the year to corporate and non-corporate providers of property, goods and services to file an information report--Form 1099--with the IRS.
September 29, 2010 comment letter to IRS
Individuals and businesses may keep their current health plans during the transition to making coverage available through health insurance exchanges.
August 12, 2010 comment letter to HHS
Insurance marketplace competition will be enhanced starting in 2014, with coverage offered through state-based Health Insurance Exchanges.
Sec. 2701 of ACA requires the Secretary of HHS to develop an initial core set of health quality measures recommended for Medicaid-eligible adults.
February 24, 2011 comment letter to HHS
Sec. 3011 of ACA requires the HHS Secretary to establish and deliver a National Health Care Quality Strategy and Plan to Congress by January 1, 2011.
October 15, 2010 comment letter to HHS
The ACA extends and simplifies Medicaid eligibility beginning in 2014 to cover all individuals under age 65 with incomes below 133 percent of the Federal Poverty Level; replaces the current standards and methods for evaluating income eligibility, and simplifies eligibility determination and enrollment and re-enrollment procedures.
February 21, 2013 comment letter
Health insurers offering individual or group coverage will be required to submit annual reports on the percentages of premiums spent on health care and quality improvement, and to provide rebates to enrollees if this spending does not meet minimum standards.
Physicians and eligible professionals who order and refer covered items and services for Medicare beneficiaries are required to be enrolled in Medicare. Providers and suppliers participating in the Medicare program must also provide documentation on referrals to programs at high risk of waste and abuse.
Section 2702 of ACA directs the Secretary of HHS to identify current state practices that prohibit payment for Health Care-Acquired Conditions (HCACs) and incorporate the practices identified, or elements of such practices, which the Secretary determines appropriate for application to the Medicaid program in regulations to be effective as of July 1, 2011.
March 18, 2011 comment letter to HHS
This proposed rule includes provisions to implement new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest.
August 31, 2010 comment letter to HHS
Preexisting condition exclusions or denials, lifetime dollar limits on benefits, and rescissions are banned except in clear cases of fraud. Patients are also protected with respect to choice of health care professionals and no prior authorization requirements for emergency care, including services provided out-of-network.
August 27, 2010 comment letter to HHS
The Secretary of HHS is required to work with states to establish an annual review of unreasonable insurance rate increases, to monitor premium increases, and to award grants to states to carry out their rate review processes.
A number of critical factors must be considered as CMS develops an implementation plan for ACA transparency reporting:
- Section 6002 of ACA calls for Reporting of Physician Ownership or Investment Interests
- Section 10331 of ACA requires CMS to establish a Physician Compare website by January 1, 2011
- Section 10332 of ACA calls for the availability of Medicare Data for Performance Measurement
The ACA requires the creation of programs for risk adjustment, transitional reinsurance, and temporary risk corridors to mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the exchanges are implemented.
October 31, 2011 comment letter